Nicholas Menecola is like many 17-year-old kids right now. He is about to graduate Grade 12, works part-time at Wal-Mart, and is anxiously awaiting acceptance to a nursing program at Ryerson University next fall.

He wants to be a nurse, to give back, he says. He is full of hope for the future.

But the Mississauga teen wasn’t always so confident about what life would hold for him. At the age of 12, Menecola weighed 220 pounds. Due to a condition unrelated to his weight he suffered pain in his legs and ankles and required surgery at the Hospital for Sick Children to repair a curvature in his legs. Post-operation, he gained even more weight.

“The healing time was six to eight months and I was very immobile during that time. I was eating the same way and putting on weight,” he recalls.

From age 12 to 16, Menecola gained about 120 pounds. “My maximum weight was 340 pounds,” he says.

In 2010, his mom read a magazine article about the SickKids Team Obesity Management Program. Through STOMP, patients can access a team of health professionals, support groups and, for those who meet specific criteria, bariatric surgery. At the time, the program was focused on teens with other health issues, such as Type 2 diabetes.

“My mom and I were desperate. I didn’t have any underlying health problems, like diabetes or high blood pressure, but my ankle and knee pain made it a hassle to walk up stairs,” he says.

STOMP takes an interdisciplinary team approach, with doctors, a dietitian, a psychologist, an exercise therapist and a nurse practitioner who oversees the patient’s care at every stage.

“We see kids at SickKids who have chronic illnesses, where obesity can affect their care. We’re also seeing more cases of Type 2 diabetes coming through our clinic so we were able to have a pilot program, which has now been extended,” says Dr. Jill Hamilton, endocrinologist and medical director of STOMP.

When the program began, Hamilton saw just how alienated many of the teens had become trying to cope with their obesity. “I was amazed at how many kids we have seen who haven’t been attending school regularly or at all. They suffer from severe bullying, depression, low self-esteem and many have family members who have struggled with the same thing, so it can be quite challenging in that way.”

In fact, Menecola’s mother, Biagina Rizzo, was also overweight. She had gastric bypass surgery in October 2010 and has lost more than 100 pounds since. Encouraged by her success, Menecola joined STOMP in December 2010.

Working in groups of eight to 10, the teens learn how to choose healthier options and share ideas. “I called it a form of mental detoxification — they take your old habits and put new ideas in place in a practical sense,” Menecola says.

After three months, he had lost 20 pounds and the team was looking at surgical options. In August 2011 and weighing 300 pounds, he had a Roux-En-Y gastric bypass, a form of bariatric surgery. SickKids has the only pediatric bariatric program in Canada.

“You remove a large portion of the stomach and re-attach the small bowel to the end of the esophagus, so that a lot of the food is bypassing the stomach,” explains Hamilton.

Menecola has lost 80 pounds since the surgery, now weighing 220.

“It’s a good feeling,” he says. “I feel a lot different. I used to have severe pain — going to a school dance, sometimes, I would sprain my ankle because I wanted to move like my friends did. Now, I can go and not second-guess what I want to do,” he says. “I have a lot more energy and can walk up three flights of stairs and not be as winded as I used to be.”

Menecola admits life has changed significantly when it comes to eating, but he was prepared for that and knows he will have to manage that the rest of his life.

“You can’t eat as much. I can’t have pop or anything carbonated. I can’t have a lot of sugar or caffeine but those things are already bad for you. I can still have treats but eat smaller portions.”

He says he couldn’t have gone ahead with the surgery without the support and lessons learned at STOMP.

“It was effective because there was a lot of support from different avenues. For me, it was about learning about exercise and what foods to include in my diet to help the exercise pay off,” he says.

Menecola cautions that the choice to have surgery was not an easy one. “It’s about making an informed decision — it’s a lifetime commitment. It’s not a quick fix at all, it’s a tool and you have to respect it. If you want to change your life, you have to be committed and wake up and want to make the change.”

He still goes to STOMP and is in the mastery group — a post-surgery group session held once a month.

“I find I’m more spontaneous now. I used to second-guess myself a lot. If my friends were going to Wonderland, I used to think I couldn’t get on the ride,” he says. “I don’t have the same anxiety that I can’t do what other people can do and I don’t have the anxiety that I’m going to die at a young age because of my weight.”

He’s also come to appreciate other aspects of his weight loss. “There are little things like I never thought I had a collarbone but I can feel it now. Just little things — it’s a rush; you’re actually changing your life.”

Changing behaviour

Many of the teens in STOMP have struggled with weight issues their entire lives, and experienced multiple failed attempts at various diet and exercise programs. STOMP not only helps many kids get on track to lose weight on their own, it can also prepare them for life-changing surgery.

“We know from the literature that, in general, lifestyle changes can reduce weight between 5 and 10 per cent. But when you’re coming in already with a body mass index of 60 or weighing close to 400 pounds — 5 to 10 per cent is not really going to make a huge difference in terms of some of the issues they are facing,” says Dr. Jill Hamilton, endocrinologist and STOMP’s medical director.

But bariatric surgery can help reduce weight by about 33 per cent.

Hamilton says STOMP is careful about how it selects teens for the surgery. Of the 100 kids who have gone through STOMP in the past two years, about 10 have had bariatric surgery.

“We’re really careful about how we select teens to do this. It’s a relatively new procedure in this age group and they have a long life ahead of them, hopefully, and we want to set them up in the best way possible for success,” says Hamilton. “So there’s a process for evaluation, education and they have to have the right supports in place and show the commitment to making changes, because it’s not a cure, it’s a tool.”

The program was first opened for teens between 12 and 17 with severe complex obesity and other chronic issues related to obesity, such as Type 2 diabetes or sleep apnea.

Patients participate in STOMP sessions one afternoon per week for six weeks, covering the curriculum and introducing them to cognitive behavioral therapy to promote change. Then they return every two weeks for a year. “We then try to transition them to community resources at the end of the two-year period,” says Hamilton.

The program accepts 50 new patients per year. At any given time, there are about 100 kids in the program.

“We’re one piece of the puzzle, but we need lots of public health initiatives with prevention very early in life,” adds Hamilton. “We’re hoping to start an under-6 program for kids with obesity that is parent-directed. Research has shown that’s where you can make the biggest difference with health changes at that age. That’s the next plan in our program.”

In an ideal world, Hamilton says SickKids would have a parallel program for parents. “Obesity is strongly genetic — up to 60 to 80 per cent of risk of obesity is based on your genes. The best is when we can engage the whole family, because then the home environment changes.”

— Jennifer Brown

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